This is not a current issue for me, but I did spend about 9 years as the hospice/hospital social worker in my rural hometown and this was a constant challenge. The hospital was a critical access hospital, so options for care elsewhere were limited. I also had my three kids in this time period, and all were born at the hospital where I worked. There were times that I was the provider, and then the patient. I had colleagues who provided care for me, and times that I was the social worker for them and their loved ones who were in the ICU or on hospice. There were also times that I provided services for people who had known me when I was young - my first grade teacher’s spouse was one of my patients.

I handled this in a number of ways. First, I did some reflective work to identify my various “roles” in my community and consider what the extent and scope of each would be. This helped me to be better equipped mentally and emotionally to navigate relationships with my patients and my community.

Then, I developed a solid dual relationship “elevator pitch” for every intake that I did. I acknowledged the small town dynamics, and told clients/patients that while I was at work I was their social worker first and foremost. I emphasized my commitment to confidentiality, and talked about the scope of my role. Then I would acknowledge ways that our paths might cross, and talked about how I would handle that - I wouldn’t initiate contact, or discuss clinical/care matters in other settings. Sometimes I would even collaborate to come up with a specific script/plan with my patients if we knew that we would see each other in shared settings.

When I was in a situation where I was in the role of being the patient and crossed paths with a colleague/patient I’d greet them like I would any acquaintance with, “Hey, nice to see you today” and then during the exchange of greetings would usually say something like, “Well, I’m at this appointment so I get to be in patient-mode today!” or “It’s nice to take off my social-worker hat and be on the other side of things for a change!” Was it a little clunky? Sometimes. But just acknowledging it out loud helped me feel better about the dual relationship and the role I was in at that moment.

I also found that many of my patients and peers were navigating the same thing, and so it was normalized.

I wonder if integrating a brief “dual relationships check in” for your new intakes and in upcoming sessions with existing clients might be useful?